Cutaneous malignant melanoma of the head and neck: the role of planned definitive surgery

The chart of 56 patients, consecutively operated on in our institution for malignant melanoma of the skin in the head and neck area from 1977 to 1993, were retrospectively reviewed. The follow-up was 2 to 18 years (average 7.5 years). We considered three kinds of treatment, looking at the adequacy and timing of surgery: (1) Planned definitive surgery (PDS), when surgery with adequate margins and lymph node dissection was done within two months after the initial diagnosis; (2) non-planned definitive surgery (non-PDS), when at least one of the above parameters could not be achieved; (3) and salvage surgery (Ss), for patients who presented with local recurrence or involved lymph nodes. Twenty-four patients were in the first group, ten in the second, and 22 in the third. Elective neck dissection was performed in 16 patients with a superficial spreading melanoma (SSM) or nodular melanoma (NM) lesion thicker than 1 mm, and a therapeutic radical neck dissection in 17 patients with a suspicious lymph node occurring at any stage of the disease. According to the type of surgical management, the five year survival was 90%, 60%, and 25% for PDS, non-PDS, and Ss groups, respectively (p<0.01), Patients who were initially treated with elective lymph node dissection had better prognosis than those who had therapeutic lymph node dissection (88% versus 19% at 8 years, p<0.001). These results further support the benefit of planned surgical treatment, i.e. within two months, for malignant melanoma of the head and neck.